Nursing Elites

1. Which referral would be most appropriate for the client diagnosed with thoracic outlet syndrome?

• A. The physical therapist
• B. The thoracic surgeon
• C. The occupational therapist
• D. The social worker

Correct answer: C

Rationale: The correct answer is C, the occupational therapist. An occupational therapist specializes in helping individuals with activities of daily living, ergonomic assessments, and adaptive techniques. In the case of thoracic outlet syndrome, an occupational therapist can provide exercises and adaptations to improve the client's function and alleviate symptoms. Choosing the physical therapist (choice A) may also be beneficial for rehabilitation exercises, but occupational therapists focus more on functional activities. Referring to a thoracic surgeon (choice B) would be more appropriate for surgical interventions rather than initial management. Referring to a social worker (choice D) may not directly address the physical symptoms and functional limitations associated with thoracic outlet syndrome.

2. A patient with chronic renal failure should avoid which of the following?

• A. Potassium
• B. Calcium
• C. Iron
• D. Zinc

Correct answer: A

Rationale: Patients with chronic renal failure should avoid potassium due to impaired kidney function. The kidneys play a crucial role in regulating potassium levels in the body. In renal failure, the kidneys may not be able to excrete excess potassium effectively, leading to hyperkalemia. Calcium, iron, and zinc are not typically restricted in chronic renal failure unless there are specific individual circumstances, making them incorrect choices.

3. The nurse is teaching a community class to people with Type 2 diabetes mellitus. Which explanation would explain the development of Type 2 diabetes?

• A. The islet cells in the pancreas stop producing insulin
• B. The client eats too many foods that are high in sugar
• C. The pituitary gland does not produce vasopressin
• D. The cells become resistant to the circulating insulin

Correct answer: D

Rationale: The correct answer is D. In Type 2 diabetes, the primary issue is insulin resistance, where cells do not respond effectively to insulin. Choice A is incorrect because in Type 1 diabetes, the islet cells in the pancreas stop producing insulin. Choice B is not directly related to the development of Type 2 diabetes but rather to its management. Choice C is incorrect as it refers to a dysfunction in vasopressin production, which is not related to Type 2 diabetes.

4. Six hours after major abdominal surgery, a male client complains of severe abdominal pain; is pale and perspiring; has a thready, rapid pulse; and states he feels faint. The nurse checks the client’s medication administration record and determines that the client receives another injection of pain medication in an hour. What is the appropriate action by the nurse?

• A. Explain to the client that it is too early to have an injection for pain
• B. Call the practitioner, report the client’s symptoms, and obtain further orders
• C. Reposition the client for greater comfort and turn on the television as a distraction
• D. Prepare the injection and administer it to the client early because of the severe pain

Correct answer: B

Rationale: The correct action for the nurse to take in this situation is to call the practitioner, report the client’s symptoms, and obtain further orders. The client's symptoms, including severe abdominal pain, pallor, perspiration, thready rapid pulse, and feeling faint, are indicative of potential complications like internal bleeding, which require immediate medical evaluation. Explaining to the client that it is too early for pain medication or repositioning the client for comfort are not appropriate actions given the severity of the symptoms. Administering the injection early without consulting the practitioner can be dangerous and may worsen the client's condition.

5. The nurse is caring for clients on a medical floor. Which client will the nurse assess first?

• A. The client with an abdominal aortic aneurysm who is constipated
• B. The client on bed rest who ambulated to the bathroom
• C. The client with essential hypertension who has epistaxis and a headache
• D. The client with arterial occlusive disease who has a decreased pedal pulse

Correct answer: C

Rationale: The correct answer is C because epistaxis and headache in a client with hypertension are signs of a hypertensive crisis, requiring immediate intervention. Option A is incorrect as constipation in a client with an abdominal aortic aneurysm, though important, does not indicate an immediate need for assessment. Option B, a client on bed rest who ambulated to the bathroom, does not present with urgent signs or symptoms requiring immediate assessment. Option D, a client with arterial occlusive disease and a decreased pedal pulse, needs attention but is not the priority compared to a hypertensive crisis with epistaxis and headache.

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